DOCUMENT RESUME ED 283 023 CE 047 486 Wojcik, Roseann B ... · assembling, and wrapping the medical instruments used for vaginal and abdominal hysterectomies. Appendixes to the module

DOCUMENT RESUME

ED 283 023 CE 047 486

AUTHOR Wojcik, Roseann B.; Moseley, James L.TITLE A Module for Hospital Central Processing Technicians

on Decontamination, Assembly and Wrapping Concepts ofGYN Hysterectomy Instruments.

PUB DATE 87NOTE 71p,PUB TYPE Guides - Classroom Use - Materials (For Learner)

(051)

EDRS PRICE MF01/PC03 Plus Postage.DESCRIPTORS *Allied Health Occupations Education; *Biomedical

Equipment; *Equipment Maintenance; Gynecology;*Hospital Personnel; Medical Services; *Supplies;*Surgery

IDENTIFIERS *Hysterectomies

ABSTRACTThis learning module can be used as an orientation

guide, inservice tool, or resource guide for hospital centralprocessing department technicians and instructors. It containsinformation sheets, worksheets, worksheet answers, a posttest, andposttest answers on correct procedures for decontaminating,assembling, and wrapping the medical instruments used for vaginal andabdominal hysterectomies. Appendixes to the module include aglossary, illustrations of procedures involved in preparing andwrapping for sterilization (using both the envelope and oblongwrapping methods), abdominal and vaginal hysterectomy count sheets,and a list of references and suggested readings. (MN)

***********************************************************************Reproductions supplied by EDRS are the best that can be made

from the original document.***********************************************************************

A MODULE

FOR

HOSPITAL CENTRAL PROCESSING TECHNICIANS

ON

DECONTAMINATION, ASSEMBLY.AND WRAPPING CONCEPTS

OF

GYN HYSTERECTOMY INSTRUMENTS

BY

ROSEANN B. WOJCIK, B.S.N., RN.

AND

JAMES L. MOSELEY, Ed.D.

U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

his document has been reproduced asreceived from the Person or organizafionoriginating it

0 Minor changes have been made to improvereproduction Quality.

Points of view or opinions stated in this docu-ment do not necessarily represent officialOERI position or policy.

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

.reAi

AK,,, _

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

2 BEST COPY AVAILABLE

TABLE OF CONTENTS

I. Introduction 1

II. Directions 2

III. Objectives 3

IV. Pre-entry Checklist 9

V. Pretest 6

VI. Pretest Answers 12

. VII. Decontamination 13

VIII. Review of Decontamination Concepts 17

NI. Worksheet # 1 18

X. Worksheet # 1 Answers 21

NI. Assembly 23

XII. Review of Assembly Concepts 26

XIII. Worksheet # 2 27

XIV. Worksheet # 2 Answers 30

XV. Wrapping, 32

XVI. Review of Wrapping Concepts 37

XVII. yorksheet # 3' 38

XVIII. Worksheet # 3 Answers 41

XIX. Conclusion 43

XX. Posttest 44

XXI. Posttest Answers 49

XXII. Glossary of Terms.,,,Appendix,A 51

XXIII. Preparing for Sterilization - Appendix B 54

XXIV. Wrapping for Sterilization - Appendix C 56

XXV. Euvelope Method of Wrapping - Appendix D 58

XXVI. Oblong (Square) Method of Wrapping - Appendix E 61

XXVII. Abdominal Hysterectomy Count Sheet - Appendi- r"' 63

XXVIII. Vaginal Hysterectomy Count Sheet - Appendix G. 65

XXIX. References and Suggested Readings 67

ii3

ABSTRACT

Central processing technicians are a vital link in the chain connected to the

healing process of almost all the patients cared for in a hospital. This module

stresses the comprehension of good technique and skills needed to produce sterile

GYN instruments and sets utilized in the operating room. The processing involves

detailed steps utilized in the decontamination, assembly and wrapping of individual

items and instrument sets that are accomplished in the central processing areas. A

pre-entry checklist determines eligibility to begin the module and successful complet-

ion of a worksheet, which is included after each of the three phases, determines

whether or not the technician can proceed to the next skill concept. Resources and

a glossary are listed that may enable the technician and/or instructor to answer

questions or problems that arise. This module can be utilized as an orientation

guide, an inservice or continuing education tool, or as resource material for

hospital CPD technicians and instructors.

INTRODUCTION

Instrument processing! This is a very important and critical mechanism in

which the end results provide the operating room with sterile instruments that are

necessary for performing emergency and elective procedures on patients. Imagine

what would occur if this process was eliminated. Post-operative infections would

soar! Diseases would be transmitted not only from patient to patient, but the

physicians and the operating room staff would contact them as well.

Throughout history, aseptic technique has been the foundation on which modern

day surgery has evolved. In 460 B.C., Hippocrates, who is considered the father of

surgery, boiled water to irrigate operative wounds. During the second century A.D.,

Galen, a Roman, Boiled his instruments before using them in surgical procedures. In

1850, Louis Pasteur found that microorganisms (germs) were killed by heat in a process

called fermentation. Joseph Lister, in 1860, learning about Pasteur's work, related

the germ theory to infection. However, during this era, Semmelweis probably contri-

buted one of the most significant impacts to the surgical process, that of washing

his hands in between patients. All of these people and their methods have contributed

to the beginning of the age of modern day surgery.

Because all patients admitted for surgery deserve and are entitled to the best

care that is available, the central processing technician has an important respon-

sibility in helping to render this care through knowledgeable skill in the handling

and processing of surgical instruments. Therefore, this module is designed to provide

the technician an avenue to learn, review, or update knowledge related to GYN instru-

ment processing techniques. This self-instructiona1 program is an overview of all

important concepts related to the processing of GYN instruments.

1 5

DIRECTIONS

1. This module is self-instructional which allows you to progress at your own rate

in order to master the specified facts or concepts. The program is constructed

so that you can focus on techniques and skills that must be acquired to success-

fully complete all stages of instrument processing. It may also be utilized for

orientation of new employees, inservice or continuing education of technicians

to maintain competency. Hopefully, this module will be a valuable tool for

educational purposes and a resource agent for you in the central processing

department.

2. As you read this document, you are asked to respond to the questions. Writing

responses and checking them for accuracy is a good reinforcer of learning.

3. Correct responses are found on pages i2, 21, 30, 41 and 49.

4. This module will take approximately one hour to complete.

5. A posttest, taken upon completion of the module, is found on page 44.

6. This document is yours to keep. Use it for future reference.

2 6

OBJECTIVES

INSTRUCTIONAL GOAL:

Central processing personnel will demonstrate ability in the processing of GYN

hysterectomy instruments. The sets will be assembled according to proper identi-

fication, number and sequence as set forth in the hysterectomy instrument count

sheet found in Appendicies F and G on pages 63-64; 65-66.

PERFORMANCE OBJECTIVES:

1. After observing a demonstration on removing hysterectomy instruments from a

case cart located in the decontamination area, you will repeat the demonstration

according to the standard procedure.

2. Following a discussion related to instrument weights, you will state two reasons

for not loading instrument trays more than the 17 lbs. indicated ih the American

Sterilizer Company's standard of practi-. policies.

3. When asked, following a discussion concerning proper tray structure, you will be

able to state two reasons why wire mesh trays are used for the processing of

instrument sets at all times.

4. Following a demonstration on placement of instruments into wire trays, you will

be able to choose all the heavy retractors to be placed on the bottom of a wire

mesh tray before placing the lighter instruments on top of the retractors.

5. When asked, you will be able to list three reasons why all instruments are

always unlocked before being placed in trays for washing.

6. Following a discussion and demonstration on washer cycle techniques, you will

choose with complete accuracy the correct washer cycle.

7. Following a lecture on sonic usage, you will be able to apply two rules for

safety involved in the operation of a sonic washer.

3

8. Given the reasons for utilizing a milk bath, you will be able to state two

problems that occur if instruments are not always milked each time they are

processed.

9. Given a towel and-a towel covered table area, you will completely dry all

instruments before attempting to assemble them.

10. Given the hyste>.:oiroy instrument list, you will identify with 100% accuracy

all the individual instruments in the set.

11. Following a demonstration on stringing instruments on an instrument bar, you

will repeat the demonstration according to the correct sequence, kind and

number of instruments placed on the bar.

12. When requested, you will he able to classify scissors as to "mayo" or

"metzenbaum" according to the description in the GYN instrument manual.

13. FolloWing a discussion and demonstration on wrapping procedures, you will choose

with 100% acctracy the correct size wrapper in which to wrap hysterectomy sets.

14. Given the theory on standards for wrapping instruments, you will express in

detail the main reason for double-thickness wrappers being used to wrap

instrument sets.

15. Following a demonstration on the oblong (square) method of wrapping a large

instrument set, you will repeat the demonstration with 100% accuracy.

16. Given the reasons for the use of gas and steam indicator strips being placed in

all instrument sets, you will prove efficiency by correctly choosing the proper

indicator strip for each set processed.

17. When asked, you will claLssify materials in the set as metal or perishable

according to the American Operat:Ing Room Nurses's sterilization standards.

18. Following a demonstration on proper sealing of instrument wrappers, you will

correctly seal the instrument set, identify tbe set, label the set, initial the

set, and stamp the current date and the expiration date 100% of the time.

4 8

PRE-ENTRY CHECKLIST

It is necessary that you have acquired certain skills before you begin work on

this module. Therefore, please check "Yes" or "No" on the appropriate lines indicating

whether or not you have mastered prerequisites.

Pre-entry Skills YES NO

1. I am able to follow detailed instructions printed on

instrument count sheets.

2. I can make appropriate decisions based on CPD's policies

regarding instrument processing.

3. I can lift 17 to 25 lbs. and carry this weight 25 to 50

feet.

4. I can identify GYN instruments by name and can pick them

out of a set as requested.

5. I can maintain sufficient manual dexterity to wash, assemble

and wrap instrument sets and individual items.

6. I am knowledgeable in gas and steam methods of sterilization.

7. I maintain clear concepts of clean/dirty and sterile/

unsterile products.

IF YOU HAVE ANSWERED "YES" TO ALL OF THESE QUESTIONS, TURN THE PAGE AND CONTINUE

WITH THE MODULE. IF YOU HAVE ONE OR MORE "NO" ANSWERS, SEE THE LIST OF SUGGESTED

REFERENCES LISTED ON THE BOTTOM OF THIS PAGE THAT CAN HELP YOU IN REFRESHING YOUIZ

PREREQUISITE SKILLS.

Gruendemann, Barbara J; and Meeker, Margaret Huth. Alexander's Care of the Patient in

Surgery, 7th ed. St. Louis: The C. V. elosby Company, 1983.

Kirkwood, Edna K. "Guideline for Preparing and Sterilizing Wrapped Packs," AMSCO

Technical Manual, (1983) pp. 1 - 7.

59

PRETEST

DIRECTIONS: Now that you have the necessary prerequisites, try your hand at the pretest

which follows. This is an assessment of the objectives stated on pp. 3 - 4 before

instruction. For the incomplete statements 1 - 10 below, one or more of the completions

are correct. Decide which completion or completions are correct and fill in the blank

with one of the following numbers next to "YOUR CHOICE" if:

1. A, B, and C are correct

2. A and C are correct

3. B and D are correct

4. Only D is correct

5. All are correct

YOUR CHOICE

The first question is answered for you.

1. In order to sterilize instruments, which method or methods would be most appropriate?

A. Boiling instruments in water

B. SoaXing instruments in a disinfectant

C. Heat instrumens until too hot to touch

D. Terminal sterilization (autoclaving)

YOUR CHOICE 4 (Only D is correct)

2.Which method or methods are means of sterilizing instruments or implants?

A. Gas

B. Steam

C. Cold (cidex)

D. Boiling water

YOUR CHOICE

6 1 0





5. All are correct

3. Which item or items are necessary when wrapping instrument sets for sterilization?

A. Label with identity of set

B. Date of expiration

C. Chemical indicator

D, Sterilization tape

YOUR CHOICE

4. Which conditions are necessary for proper assembly of instruments?

A. Clean, dry and unlocked

B. Lubricated (milked), flat and unlocked

C. Sharp ends protected, stringers and a pan lined with a foam liner

D. None of the above.

YOUR CHOICE

5. What is the primary reason for sterilization of instruments?

A. So patients in surgery are operated upon using warm instruments

B. To give central processing technicians a standard to follow

C. For adherence to CPD policies

D. To kill all microorganisms (bacteria and spores, viruses, fungi, etc.)

YOUR CHOICE

7 11





5. All are correct

6. If the operating room called for a sterile punch biopsy forcep to be sent to

the OR and you accidently dropped the packaged forcep on the floor, which action

or actions would be most appropriate in this situation.

A. Send the punch biopsy forcep to the OR anyways because it is packaged

B. Call the OR and tell the nurse that you do not have a punch biopsy forcep

because you will get in'trouble if you tell the truth about the matter

C. Ignore the call and do nothing about the request because you are busy

D. Look for another sterile punch biopsy forcep and send it to the OR

YOUR CHOICE

7. If a sterile item which the OR has requested has a tear in the wrapper, which

action or actions Wou1dAe2.considéred?appropriate?

A. Send the item to the OR with the tear in the wrapper

B. Quickly re-wrap and sterilize the item and hope the OR does not notice

the delay

C. Take care of the request later because you are assigned to wrapping sets

D. Call the OR, explain the problem and let the OR decide whether or not the

item is still wanted

YOUR CHOICE

8; 2





5. All are correct

8. If an important GYN instrument is missing from the'set you are assembling, which

action or actions should you take?

A. Call the OR to find out if the instrument was not returned to CPD from OR

for a particular reason and follow their direction on whether or not to

wrap the set

B. Wrap the set without the missing instrument and process it because it will

turn up later

C. Search your work area and if tne instrument is not found, tty to locate

another in the back-up instrument storage area. If one is not found,

wrap the set

D. None of the above

YOUR CHOICE

9. If you do not recognize a particular GYN instrument and it is supposed to be

wrapped and sterilized, which action or actions should you undertake?

A. Leave the instrument alone and let someone else worry about it

B. Look up the identificaticn in the instrument resource book

C. Place the instrument in the back-up storage bin letting someone else put

it in its correct place

D. Ask an experienced CPD technician, supervisor, or inservice instructor for

the identification of the imttl'ument and the appropriate processing method

YOUR CHOICE

1. A, B. and C are correct




5. All are correct

10. Which are incorrect weights of instrument sets to be sterilized?

A. 50 lbs.

B. 17 lbs.

C. 30 lbs.


YOUR CHOICE

DIRECTIONS:

For the following questions 11 - 16 below, the statements are either True or False.

If the statement is True, circle A; if the statement is False, circle B.

11. Steam sterilization can be used to sterilize all instruments and materials?

A. True

B. False

12. Ethylene oxide mixture is a form of steam sterilization?

A. True

B. False

13. A cover gown or lab coat should be worn over scrub suits when leaving the

central processing department?

A. True

B. False

10 4

14. Shoe covers are not necessary because you keep your shoes clean when working in

the central processing area?

A. True

B. False

15. All hair should be covered when working in any of the CPD areas?

A. True

B. False

16. Washing your hands after completing personal grooming and hygiene acts is not

necessary because instruments will be sterilized anyways?

A. True

B. False

TURN TO PAGE 12 TO CHECK YOUR ANSWERS

11

1_5

PRETEST ANSWERS

MULTIPLE CHOICE:

1. 4 6. 4

2. 1 7. 4

3. 5 8. 2

4. 2 9. 3

5. 4 10. 2

TRUE OR FALSE

11. B - Steam sterilization cannot be utilized for perishable items.

12. B - "hylene oxide mixture is a form of gas sterilization.

13. A

14. B - Shoe covers are necessary to prevent dirt, which is present on the soles of

shoes, from being transferred into the CPD areas.

15. A

16. B - Washing your hands is always necessary when completing acts of personal

hygiene because microorganisms are present on everyone's skin and could be

transferred to materials present in the CPD areas.

IF YOU HAVE SUCCESSFULLY COMPLETED THE PRETEST BY ANSWERING ALL THE QUESTIONS

CORRECTLY, YOU ARE TO BE CONGRATULATED. YOU KNOW THE SKITXS AND CONCEPTS DISCUSSED

IN THE MODULE AND ro NOT NEED TO PROCEED ANY FURTHER.

HCWEVER, IF YOU HAVE NCT ANSWERED THE QUESTIONS WITH 100% ACCURACY, BEGIN

READING THE MODULE. Appropriate directions will be given as you proceed.

12 16

DECONTAMINATION 1

GERM THEORY:*

Microbiology is the science that sutdies all forms of microorganisms, both

plant and animal. A germ is an example of a living organism that is familiar to

most people. They are so small that they can be seen only through the powerful lens

of a microscope. They are classified according to size, shape, staining properties,

spore-forming aspects, and whether or not they produce disease. Therefore, as a

central processing technician, you should be able to visualize in your mind's eye

the microorganisms that you can never see with the naked eye. Even though micro-

biology includes the study of yeasts, molds, fungi, rickettsia, and parasites, the

two divisions of microorganisms of prime interest to you are bacteria and viruses.

Bacteria, which are minute, one-celled, plant-like organisms come in one of three

shapes. The coccus or spiral-shaped, the bacilli or rod-shaped, and the spirillum

or spiral-shaped cause disease. Bacteria possess a cell wall, cytoplasm, and thin

filaments called flagella which help them move about. Bacteria must obtain their food

from outside sources and absorb their food directly through their cell walls. Same

bacteria live where there is no air or oxygen and cannot live if air is present.

These are called anaerobes. Other bacteria which require oxygen and air in which to

grow are cal.led aerobes. Some bacteria, especially the rod-shaped ones, have the

ability to form resistant bodies called spores. These spores can produce a wall

around their cells which make them extremely resistant to temperatures and moisture

in order to destroy (kill) them. Unfortunately, spores can lie dormant for long

periods of time and when favorable conditions appear, they can come to life.

Viruses are the most primitive form of life and are minute disease-producing

particles that are not easily distinguished. Even in utilizing a mdcroscope, there

is difficulty in determining their status as living organisms. They are so small

* For definitions, refer to the Glossary of Terms found on pages 52 and 53.

13 17

that they cannot live outside of a living host. Howaver, it is generally accepted and

documented by research that methods capable of destroying bacteria will also destroy

viruses.

Remember, only a few microorganisms cause disease. Many others are beneficial

and, for example, are used in the production of antibiotics. The pathogens are the

best known because these microorganisms cause disease in man and animals. But, in

today's hospitals, most infections are nosocomial (hospital-acquired) and not

pathogenic. The highest percentage are from the E. Coli, a gram-negative rod found

in averyone's intestinal tract; this is the cause of the highest percentage of hospital-

acquired disease. However, healthy individuals are not normally troubled by this

bacteria because we all harbor it. But, a person who is ill, or weakened by surgery,

is more susneptible to infections and rampant growth of this bacteria often. causes

infection in other parts of the body. Therefore, it is the pathogenic and E. Coli

infections that you, as a central processing technician, must consider in your efforts

of sterilizing instruments and items used on patients in your hospital. You are a

prime determinant of effective infection control and indifference or carelessness make

this control difficult. So, you must constantly wage a battle against infectious

organisms to ensure both patient and your own safety.

Statistics show that large quantities of bacteria are present in the nose and

mouth, on the skin and on the attire of personnel who work in the central processing

area. Therefore, a locker room is provided where you can remove your personal clothing

and don scrub suits to eliminate these large amounts of bacteria from being transported

into the CPD area. Daily body cleanliness and clean, dandruff-free hair help keep this

area free from excessive bacteria. Because hair acts as a filter when left uncovered,

it collects bacteria whidh are released into the air during activity. Disposable

surgical caps or hoods are worn to prevent this problem. Shoe covers help prevent

cross contamination from other perts of the hospital. They must be put on before

entering the area and removed before leaving CPD. When leaving the CPD area, a lab


14

coat should be worn to prevent contamination of the scrub suit worn underneath.

CLEANING:

Cleaning is the first step instruments undergo in the processing method. You

are aware that if an instrument is not cleaned thoroughly, sterility can not be

achieved. Therefore, there are specific steps that must be followed to ensure that

cleanliness is accomplished. The case cart is transported from the operating room

to the decontamination area of the central processing department via the 'dirty"

cart lift. This case cart contains all the soiled linen, garbage and instruments

used in a surgical procedure. As soon as the case cart is removed from the lift, the

doors are opened and the garbage and linen bags are discarded into the appropriate

receptacles. Next, the basins and pans are removed. After this, the instrument set

is removed from the cart. To do this, slide the instrument set to the edge of the

wire rack holding the tray. Take hold of the handles located on each side of the

tray, slide off the edge, lifting the instrument tray and loading it on the rubber

maid cart for transportation to the sink area. The instruments in the tray should

weigh no more than 17 lbs. But, if they do, placing the set on the cart facilitates

easy transport to the sink area.

Select a wire mesh tray from the wire rack and proceed to place the instruments

into the tray. Place all the heavy retractors on the bottom of the tray and the

lighter instruments on top of the retractors. If need be, use two trays instead of

overloading the initial tray. Be sure to unlock all instruments so that all debris

can be removed during the washing process. Inspect the tips of instruments before

washing for signs of breakage, cracks, misalignment and raw edges. If any of these

problems are found, wash the instrument by hand and set it aside for repair.

Next, place the wire tray into the sonic washer. Through this process, soil is

removed by a physical shaking action. This ultrasonic cleaner is a machine which

uses ultra-sound waves in water to clean the instruments by cavitation (the formation


15 19

of partial vacuums in a liquid by high-frequency sound waves). One important pre-

caution is necessary in utilizing the sonic washer. Be sure to remove all sharps be-

fore placing the tray of instruments into the sonic washer. If you do not, the tips

on needles and other sharps will protrude through the wire mesh causing breakage to

the instrument or a possible safety hazard to the processor such as a puncture wound

or cut. Irstruments that are in poor condition are also a hazard to a patient in the

operating room. Tips that are cracked or bent can break off during an operative pro-

cedure can be left in the patient. Therefore, it is essential that every percaution

be undertaken to maintain the instruments in the best possible condition for surgical

usage.

Set the sonic washer for 10 minutes. When the cycle is complete, rem:we the

instruments from the sonic and again place the set on a towel lined rubber maid cart.

Transport the cart with the instrument tray to the washer/sterilizer. Place the

instrument tray into the washer/sterilizer basket and place the wire cover on top.

Position the basket on the runner and push into the machine. Activate the cycle by

pushing the start button. The cycle will run for 16 minutes.

In utilizing either the sonic or washer/sterilizer or both, make sure all sharps

are removed such as scapel blades, tips from bovie cords, etc. No electrical instru-

ments are to be submerged or placed in either the sonic or washer/sterilizer because

if you do, the electrical wiring and intricate components will become moist causing a

short in the electrical system.

In the decontamination area, all electrical equipment and small items such as

screws and small instruments such as eye instruments are to be washed by hand to pre-

vent breakage or destruction of vital components. This area has no allotment for

careless or inappropriate handling of instruments. Instruments are expensive and

their longevity for use in surgical procedures depends a great deal on how they are

cleaned and cared for in the central processing area.


16 410

REVIEW of DECONTAMINATION SKILLS

Bacteria that are capable of forming spores make those bacteria resistant to

heat. Mdcrobiology is the science that studies all forms of plant and animal life.

Three shapes in which bacteria are formed are sphirical or coccus, bacilli or rods,

and spirillum or spiral. Bacteria that live in the presence of air and oxygen are

called aerobes and those that live in environments without air or oxygen are called

anaerobes. The highest percentage of nosocomial infections are caused by E. Coll, a

bacteria commonly found in everyone's intestinal tract. Most microorganisms do not

cause disease in man or animals. Pathogens are the microorganisms most likely to

produce disease. Bacteriaarefound mostly everywhere, especially in the nose and

mouth, skin, and on the attire of people working in CPD.

To remove instruments from a case cart, you should slide the tray to the edge

of the rack and remove it by taking hold of the handles and slide it toward the end

of the rack near the opening of the cart and then lift the tray out of the cart.

Tips of instruments are always examined for breakage, misalignment, cracks, and raw

edges. In utilizing a sonic washer, remove all sharps before putting a set into the

sonic. No electrical equipment should be placed into a sonic at any time. The sonic

washer cleans by ultrasound waves which clean by cavitation. No instrument tray'

should weigh more than 17 lbs. In placing any instrument into a tray before'washing,

unlock it so that all debris can be removed during the washing process. The washer/

sterilizer cycle runs for 16 minutes.

PLEASE GO TO WORKSHEET # 1 ON PAGE 18.

17 21

WORKSHEET # 1

DIRECTIONS: Let's reviewyoutknowledge of the skills you have just learned.

For the incomplete statements 1 - 3 below, one or more the completions are correct.

Decide which completion or completions are correct and fill in the blank with one of

the following numbers next to "YOUR CHOICE" if:





5. All are correct

YOUR CHOICE

The first question is answered for you.

1. In removing instruments from the case cart, you should:

A. Slide the instrument tray to the edge of the rack

B. Remove the cart rack with the instrument tray sitting on top of the rack

C. Remove the tray by taking hold of the handles, sliding toward the end of

the rack near the opening of the cart and lift out of the cart


YOUR CHOICE 2 (A and C are correct.)

2. Tips of instruments are examined for:

A. Breakage

B. Misalignment

C. Cracks

D. Raw edges

YOUR CHOICE

18 22

3. In utilizing a sonic washer, which precautions are necessary?

A. Place all instruments in the sonic except glass

B. Place all electrical cords in separately

C. Leave needles on bovie (cautery) cords so that they do not get lost

D. Remove all sharps before putting the set into the sonic washer

YOUR CHOICE

DIRECTIONS:

For the following statements 4 - 9 below, fill in the blanks with the correct responses.

4. Bacteria are capable of forming which make them resistant to heat.

5. is the science that studies all forms of plant and animal life.

6. Three shapes in which bacteria are formed are , and

7. Bacteria that live in the presence of air and oxygen are called

8. The highest percentage of nosocomial infections are caused by

9. A washer which removes soil through a physical shaking action is called a

washer.

DIRECTIONS:

For the following statements 10 - 19 below, the Statements are either True or False.


10. Bacteria are classified according to size, shape, staining properties, spore-

forming abilities, and whether or not they produce disease?

A. True

B. False

11. Most microorganisms cause disease?

A. True

B. False19 23

L2. Pathogens do not cause disease in man or animals?

A. True

B. False

13. Large quantities of bacteria are present in the nose and mouth, skin, and on

the attire of people working in the central processing department?

A. True

B. False

14. Ultrasound waves clean instruments by cavitation?

A. True

B. False

15. Instrument trays, when full, should weigh no more than 17 lbs?

A. True

B. False

16.. When placing instruments into trays before washing, the instruments must be

unlocked so that all debris can be removed during the washing process?

A. True

B. False

17. The washer/sterilizer cycle runs for 16 minutes?

A. Ttue

B. False

18. Pathogens are the only cause of hospital infections?

A. Ttue

B. False

19. Bacteria which require no air or oxygen in their environment are called anaerobes?

A. Ttue

B. False

ITURN TO PAGE 21 TO CHECK YOUR ANSWERS.

20 24

WORKSHEET # 1 ANSWERS

MULTIPLE CHOICE

I. 2

2. 5

3. 4

FILL IN THE BLANKS

4. Bacteria are capable of forming spores which make them resistant to heat.

5. Microbiology is the science that studies all forms of plant and animal life.

6. Three shapes in whith bacteria are formed are spirical - coccus, bacilli - rods,

and spirillum -

7. Bacteria that live in ths presence of air and oxygen are called aerobes.

8. The highest percentage of nosocomial infections are caused by E. Coli.

9. A washer which removes soil through a physical shaking action is called a

sonic washer.

TRUE OR FALSE

10. A

11. B Mbst microorganisms do not cause disease. In hospitals it is primarily the

pathogens and E. Coli microorganisms which cause disease.

12. B Pathogens are responsible for producing disease in man and animals.

13. A

14. A

15. A

16. A

17. A

2521

1.c7;, D ;:atbDgens are not the only microorganisms responsible for causing infection

.1). the hospital. E. Coli microorganisms are also responsible for a major

portion of hospital infections.

19. A

IF YOU HAVE SUCCESSFULLY COMPLETED THE DECONTAMINATION SKILLS PORTION OF THIS

MODULE WITH 100% ACCURACY, CONGRATULATIONS! YOU ARE MASTERING THE MATAERIAL.

CONTINUE READING THE MODULE.

IF YOU HAVE NOT SUCCESSFULLY MASTERED THE MATERIAL, HOWEVER, REREAD THIS SECTION

ON PAGES 13 - 17 AND REPEAT WORKSHEET # 1. IF YOU DO NOT MASTER THE MATERIAL WITH 100%

ACCURACY THIS TIME, PLEASE SEE THE INSTRUCTOR BEFORE ATTEMPTING TO CONTINUE.

ASSENBLY

GENERAL INSTRUMENT CONSIDERATIONS:

The central processing technician is responsible for the use, handling and care

of hundreds of surgical instruments a day. A basic knowledge of how these instruments

are to be protected will help in their maintenance. Because the United States does

not have an agency that reviews or sets standards for surgical instruments, the quality

is set by the individual manufacturers. If the instruments are inferior, they will not

withstand normal usage. Thus, the consumers will not receive full return on their

investments. Instruments that are properly cared for should last about 10 years or

more and a reputable company sill stand behind its products. Therefore, it is your

responsibility to know the surgical instruments and their proper uses and care.

There are four main categories of instruments: sharps, clamps, holding instru-

ments, and retractors. Sharpc include scissors and scalpels which are instruments

with sharp or cutting edges as the t able parts. Clamps are generally used as a

method of hemostasis and are the instruments that make surgery possible by preventing

excessi,a or fatal blood loss in the course of dissection. The grasping or holding

instruments are used for tissue retraction or suturing. They must possess a firm

grip while inflicting a minimum of trauma to the tissues they hold. Retractors de-

termine the exposure of the operative field. The surgeon needs the best exposure

possible while operating so as to inflict a minimum of trauma to the surrounding

It has )--.come an AORN standard of practice and national hospital policy to

have instrumen4 count sheets in all instrument sets. This is done to ensure correct

instrument counts not only during surgery but also during the processing of the sets.

Instruments should be used only for the purpose for which they were designed. Through

proper use and reasonable care, the instruments' lives are prolonged and their quality

proteci,ed. Therefore, handle +-hem gently. Bouncing, dropping, and setting heavy

23 2 7

Nuipment or items on top of them should always be avoided. Do not throw instru-

ments together or into heaps. They should be handled individually or in small groups.

Sharps and delicate instruments should be handled with upmost care and discretion.

Before assembly, you should inspect each instrument for imoerfections. An

instrument should function perfectly to prevent needlessly endangering a patient's

life and increasing operative time because of the failure of an instrument. ,,tirceps,

clamps, and other hindged instruments must be inspected for alignment of jaws, teeth

and for stiffness. Ratchets should hold firmly yet release when necessary. The tips

of jaws and teeth should meet perfectly, and joints should work smoothly. The

serrations on the ends of forceps must be perfectly fitted, so that blood flow may

be occluded but so as not to injure or cut the vein or artery. The edges of scissors

should be tested for sharpness because to cut, they must be beveled smoothly. All

instruments should be checked for worn spots, Chipping, dents, cracks, or sharp

(raw) edges.

GYN INSTRUMENTS:

These instruments are used for procedures in operations involving the struct-

ures of the female reproductive system. These procedures can be performed either

through the abdominal or vaginal routes. Therefore, the instruments are generally

placed into sets for vaginal or abdominal procedures. The following instruments are

used in abdominal hysterectomy sets: tenaculums (single and double tooth), singley

forceps, clamps (haney, rodger, kocher, kelly, allis and habr:ock), 10" needle holders,

scissors (mayo and metzenbaum, curved and straight), and an 0 Connor Sullivan

retractor. The following instruments are commonly found in vaginal hysterectomy sets:

tenaculums (single and double tooth), clamps (haney, rodger, kocher, and allis),

heany needle holders, retractors (small deavors and eastman), and a weighted speculum.

Instruments sometimes used in addition during vaginal procedures are: uterine curettes,

hank dilators, godell dilator, and forceps (ring, bdopsy, polyp, dressing, and

russians).

24 28

In order to prepare and wrap instrument sets, the sets should weigh 17 lbs. or

less. Inspect the instruments, observe for cleaniness and proper functioning. Make

sure they are dry. To ensure that steam will contact all surfaces of the instruments,

open and unlock all of them and place on an instrument stringer according to type,

number and sequence. Place instruments in a mesh-bottom wire tray which is designed

for effective sterilization, drying and orderly arrangement of the instruments. To

assist in the drying of the instruments in the sterilization cycle, place an absorbant

cloth towe foam liner in the bottom of the tray. A drying problem can occur be-

cause the coaciotration of the metal mass can cause formation of localized moisture.

An internal steam indicator is placed in the center of the instruments with the ink

side away from the metal surfaces so that no toxic substance, like ink, comes in con-

tact with the instruments.*

All sets have instrument count sheets which are placed in the set with the

identification, size, seqaence and number of each instrument that is supposed to be

placed in that set. You are to account for and accurately record next to the required

number of instruments listed on the sheet, the actual number of each specific instru-

ment and at the bottom of the sheet, the total number of all the instruments. Next,

write in the date of processing and your initials on the designated lines. When this

is completed correctly, you are ready for the next phase of processing, wrapping of

the instrument sets.**

For definitions, refer to the Glossary of Terms found on pages 52 and 53.

* Review Appendicies B and C on pages 54 - 57.

** Review Appendicies F and G on pages 63 - 66.

25 29

REVIEW OF ASSEMBLY CONCEPTS

There are four major categories of instruments. These include sharps, clamps,

holding instruments, and retractors. Instrument count sheets are to be placed in all

instrument sets before sterilization according to AORN's standard of practice. Instru-

ments should always be handled individually or in small groups, not thrown into heaps,

when being processed. All instruments should be inspected for worn spots, chipping,

dents, Cracks, or sharp edges before handling both for your own personal safety and

patient safety. A cloth towel or foam liner should be placed in the bottom of the

wire mesh tray to assist in the drying of the instruments.

Scissors can be called for by their individual names or for their usage. They

are commonly called metzenbaum, mayos, nurses, and suture scissors. The following

instruments are called by the following names interdhangeably:

1. Scalpel - knife

2. Oschner - kocher

3. Hemostat - clamp

4. Balfour - retractor

5. Schnid - beckman

6. Adson - forcep

A wire mesh tray is designed for effective sterilization of instruments, drying

of instruments, and orderly arrangement of instruments. Instruments commonly fourid

in a GYN set would include curettes, haneys, and rodger clamps. Sequence, number,

and kind refer to the stringing of instruments on an instrument bar, the utilization

of an instrument count sheet for assembling instruments, and the placement of instru-

ments into a tray.

PLEASE GO TO WORKSHEET # 2 ON PAGE 27.

26 3 0

WORKSHEET # 2

DIRECTIONS: Let's re4iew your knowledge of the skills you have just learned.

For the following statements 1 - 7 below, the statements are either Ttue or Falso.

If the statement is True, Circle A; if the statement is False, circle B.

1. There are only two major categories of instruments?

A. True

B. False

2. It is not necessary, according to. AORN's standard of practice, to have instrument

count sheets placed in all instrument sets before sterilization?

A. True

B. False

3. To properly handle instruments, they should not be thrown in heaps but should be

handled individually?

A. True

B. False

4. Inspection of instruments is not necessary before assembly because there are

many instruments from whidh to choose if one is not perfect?

A. True

B. False

5. All instruments should be checked for worn spots, chipping, dents, cracks, or

sharp edges before assembling?

A. True

B. False

6. A cloth towel or foam liner is placed in the bottom of a wire mesh tray to assist

in the drying of instruments?

A. True

B. False

3127

7. Metzenbaum, mayo, nurses and suture refer to scissors?

A. True

B. False

DIRECTIONS:

For the following statement below, match the term with its appropriate meaning.

Each answer may be used only once.

8. Match the following instruments with their appropriate meanings.

A. Scalpel 1. Kocher

B. Oschner 2. Forcep

C. Hemostat 3. Knife

D. Balfour 4. Beckman

E. Schnid 5. Clamp

F. Adson 6. Retractor

DIRECTIONS:

For the incomplete statements 9 - 11 below, one or more of the completions are correct

Decide whidh completion or completions are correct and fill in the blank with one of






5. All are correct

YOUR CHOICE

28 32

9. A wire mesh tray is designed for:

A. Effective sterilization of instruments

B. Drying of instruments

C. Orderly arrangement of instruments


YOUR CHOICE

10. Which combination of instruments would commonly be found in a GYN set?

A. Doyen, satinsky, and payr clamp

B. Weitlander, hemoclip appliers, and cystoscope

C. Rasp, chisel, and osteotomes

D. Curettes, haneys, and rodger tzlamps

YOUR CHOICE

11. Sequence, number, and kind refer to which of the following?

A. Stringing instruments on an instrument bar

B. Utilization of an instrument count sheet for assembling instruments

C. Placement of instruments into a tray


YOUR CHOICE

PLEASE CHECK YOUR ANSWERS ON PAGE 30.


TRUE OR FALSE

1. B There are four major categories of instruments: sharps, clamps, holding

instruments, and retractors.

2. B AORN's standard of practice policy encourages the use of instrument count

sheets for all instrument sets.

3. A

4. B Inspection of instruments is necessary to determine whether or not there are

worn spots, chipping, dents, cracks, or sharp edges which can be a hazard to

both the patient and the central processing technician.

5. A

6. A

7. A

MATCHING

8. A. 3

B. 1

C. 5

D. 6

E. 4

F. 2

MULTIPLE CHOICE

9. 1

10. 4

11. 1

IF YOU HAVE SUCCESSFULLY COMPLETED THE ASSEMBLY SKILLS PORTION OF THIS moruLE

WITH 100% ACCURACY, CONGRATULATIONS! CONTINUE READING THE MODULE.

IF YOU HAVE NOT SUCCESSFULLY MASTERED THE MATERIAL, HOWEVER, REREAD THIS

SECTION ON PAGES 23 - 26 AND REPEAT WORKSHEET # 2. IF YOU DO NOT MASTER THE MATERIAL

WITH 100% ACCURACY THIS TIME, PLEASE CONSULT THE INSTRUCTOR BEFORE ATTEMPTING TO

CONTINUE.

WRAPPING

MATERIALS:

The prime function of a package containing a sterile instrument or set is to

ensure that the sterility is maintained until that package is opened intentionally.

In choosing proper wrappers, 100% cotton muslin or water repellent non-woven wraps

are suitable for steam and ETO (gas) sterilization. The water repellency provides

added protection after sterilization from contamination caused by handling withmoist

hands and from absorbing humidity from the air. Because of the uniform density, the

wrappers also act to filter out airborne bacteria.

Materials used for hospital wrapping and packaging should provide a seal of

proven integrity. They should be durable to resist tears and punctures and not

delaminate when opened or allow for resealing. All materials must be free of pin-

holes and suitable for printing or labeling for package identification. The manu-

facturers of the materials should have documentation available to validate that the

materials are effectivB barriers to microorganisms as vehicles of contamination under

prescribed storage and use conditions. The criteria for determining the contamination

of package contents is reflected in the fact that contamination is event related

rather than time related. Thus probability of contamination occurring increased with

time because a contamination event is more likely to occur as time increases.

Materials used for wrapping and packaging should be free from toxic ingredients

and non-fast dyes and also be nonabrasive.. Therefore, preprinted marking labels or

adhesives should not bleed through to the items in a package. Chemicals and laundry

processing should not have deleterious effects on woven materials and also should

meet or exceed National Fire Protection Association standards. All sterilized pack-

ages should allow opening without significant risk of product contamination, damage or

personal injury. Packages that may serve as a sterile drape upon opening should drape

easily and be memory free. Also, materials should not pill, delaminate or flake off.


32 36

To maintain a shelf-life, the following criteria should be considered:

1. Single-wrapped (two-layers of 140-thread-count woven fabric, one layer of

either 270 - 280 thread-count woven fabric, or disposable material).

2. Double-wrapped (four layers of 140-thread-count woven fabric, two layers of

270 - thread-count woven fabric, or disposable material). Disposables

include two-way crepe paper, paper, plastic, non-woven or paper-plastic

combinations, and protective covers.

METHODS:

In wrapping instruments, either the envelope or the oblong (square) style is

implemented. Wtappers should be of adequate size, not excessive, because too large

of a size may cause a drying problem. All trays or instruments are wrapped stAquen-

tially using the envelope method. In utilizing the oblong method, lzrge tr-- --ay be

double wrapped using both wrappers simultaneously; otherwise, the sequentia.4 Tod

is used.

To envelope wrap a set, first lay down a set of two wrappers with a towel

placed under the instrument tray. The towel will help absorb condensation and provide

protection to the wrapper so that holes do not develop in it. Next, lift the corner

of the wrapper nearest you and fold it back as you place it over the tray in a cuff

formation. This cuff facilitates aseptic opening by the OR nurse. All wraps must

open easily and lie flat or drape easily over the OR table without forcing the wrap.

In other words, the wrapper should have no memory and ncl-woven and muslin wraps

accomplish this well. Next, bring one side over and make a cuff fold, bring the

remaining flap over the tray toward you, make sure edges are parallel with the tray.

Then, turn the tray around and tuck under the end leaving a corner exposed for easy

opening. In oreler to provide the greatest degree of sterilization assurance, double

wrap all instruments and sets. Therefore, repeat the above wrapping process by

placing the set or instrument in the center of the second wrap and proceeding.

Now, pull off a strip of steam or gas sterilizer indicator tape and seal the

33 37

package with the tape in the same Tiection.as-the-fold to minimize contamination

caused by disturbance. Identify the contents of the package by writing on the tape.

Write your initials on the tape also. Remember, the accuracy of the count and the

integrity of the wrap are your responsibility. Place the item on the proper sterilizer

cart and stamp a label on the set or item containing the date of process, sterilizer

number, load number, and expiration date before sterilization. Affix this label to

the gas or steam indicator tape. Now, the item or set is ready for sterilization.

In utilizing the oblong (square) method of wrapping, lay out two wrappers flat

on the table. Place a towel in the center and place the set on top of the two wrappers.

To use this method, one or both wrappers may be used at a time. If only one wrapper is

used at a time, the method is called sequential. Tb start, fold the far edge of the

top wrap over the set. Next, fold back the wrap and cover the set. Repeat the process

with the other, opposite side of the wrapper. Now, take the right corner of the

wrapper and fold it over the set making a cuff and tuck the cuff under the folded layer.

Repeat the process on the left side and seal the outer cuffed edge with the indicator

tape. Follow the same process for identification and dating of the set as above.*

STEAM STERILIZAIION:

Moist heat in the form of saturated steam under pressure is the most reliable

and frequently used sterilization method. It is dependable because of the ability of

steam to quickly penetrate and of the moist heat to kill microorganisms. Items are

sterile if they have complete exposure to saturated steam for 12 minutes at 250°F, or

3 mdnutes at 270°F. The total cycle can be from 8 to 60 minutes depending on how

items are wrapped, density of the load, and the method of steam sterilization employed.

Steam can be used on fabrics, instruments, metal basins and flasked liquids. It is

the most economicalsterilizing agent, leaves no toxic residue, and allows for short

exposure times. Steam is not suitable for heat and moisture sensitive items such as

certain plastics, oils, greases or powders. Avoid overloading the sterilizer. Loose

* Review Appendicies D and E on pages 58 - 62.

34 38

packing allows free access of ow, e6cape of air. Most important of all,

operate the sterilizer properly.

Moisture is formed at the beginning ot the steam sterilization cycle as the

instruments are being heated to the sterilizing temperature. As steam gives up its

heat, vaporization occurs causing a change from steam to liquid. Once the desired

temperature is obtained, further heating and condensation stop occurring but the

moisture which has formed stays during the sterilization process. This moisture is

trapped in absorbent products or remains as droplets on metal and other non-absorbant

materials.

Equipment made of metal or rubbcr does not absorb any moisture during the heat-

up phase of sterilization. Rather, the moisture collects and lies on the surface or

rolls off. Therefore, it is necessary that absorbant liners be placed beneath them to

retain the accumulated moisture so that the moisture will be dried in the drying

phase of the cycle. ,Ijoistura formed during sterilization must be removed so that

a sterile item maintains sterility in a sterile environment. Moisture that remains in

the wrappers provides a pathway for bacteria to migrate through these materials. So,

an effective drying phase must be utilized to prevent such opportunities.

Drying is the removing of condensate from an item. By using an exhaust system

in the sterilizer, vapor is removed and heat is produced to dry the materials. You

mmst personally make sure that all items being removed fran the steam sterilizer are

dry to ensure the sterility of the package contents.

GAS STERILIZATION:

Ethylene oxide in the pure form is not recommended for sterilization in the

liquid or vapor state because of its flammability and toxic hazards. Therefore, it

is mixed with inert gases such as carbon dioxide or fluorinated hydrocarbons to render

them unflammable. Temperature, moisture, concentration, and time are important

factors in using gas sterilization for perishable items. The aeration of articles is

essential so that residual gas is allowed to dissipate from the materials to an accept-

35

able tolerance level prior to usage.

The ethylene oxide process requires a careful balance of several control

factors for effective destruction of microorganisms. These factors include an am-

bient temperature of 1300 to 135°F for most heat and moisture sensitive products.

The cycle time is 2 to 4 hours with a gas concentration and relative humidity of 40

to 60;6. Gas sterilization has several advantages. Net only is it effective against

all types of microorganisms but it is non-corrosive and will not damage items. High

pressures are not necessary. However, it does require long exposure times, and com-

pared with steam, it is expensive. Items sterilized by this method must be.withheld

from use until con§idered safe, i.e., aerated sufficiently to avoid toxic affects.

Some materials such as glass and metal do not absorb gas and require no aeration.

Placement of mechanical aerators should be near gas sterilizers to assure ndnimum

exposure of sterilizer loads to the environment prior to aeration.

Materials which should not be used for packaging items to be gas sterilized

include nylon film, saran wrap, polyvinyl chloride (PVC) film, aluminum foil, and

canvas. These materials are either too tough to penetrate, hold too much gas residual,

or are so porous that once sterility is achieved, it cannot be maintained in storage.

The most desirable wrappers are combination paper/plastic or non-woven materials.

While polyethylene can be used in 3 mil thickness, no item should be wrapped with two

layers of polyethylene because of the resultant moisture and ETO barrier. Therefore,

when 1Qadirq a gas sterilizer, do not stack packaged items together too tightly.

Remember, it is most important to maintain strict adherence to the manufacturer's

instructions for operation of a gas (ETO) autoclave.


REVIEW OF WRAPPING CONCEPTS

Large GYN sets may be wrapped utilizing the oblong (square) method when using

both wrappers simultaneously. The envelope method of wrapping can also be used to

wrap GYM sets and individual instruments. The primary function of a sterile package

is to ensure that the instrument or set maintains sterility until you open it inten-

tionally. The identification of the set and your initials as the person wrapping the

set must be written on the sterilization tape before it is autoclaved. It is an

event related rather than a time related factor which determines whether or not a

set has been contaminated. All materials used in the wrapping of sets should be free

from memory, the ability to return to its original shape and countour. Metal instru-

ments such as curettes and clamps should be steamed sterilized. Those items that con-

tain plastics, oils, greases, or powders cannot be steam sterilized but rather must be

gas sterilized. Metal does not absorb moisture during the beat-up phase of sterilization.

Materials used in the wrapping of sets should be free from toxic and non-fast

dyes. Also, they should be nonabrasive to avoid scratching the instruments. All sets

being steamed sterilized require a steam indicator tape, those which are gased require a

gas indicator tape. Metal, rubber and liquids utilize steam indicator tapes. Perish-

able items require a gas indicator tape. If the chemical indicator strip does not

change after completion of the sterilization cycle, you should consider the set not

sterile. Also, consider the possibility of facuty indicator tape. Gas .

is effective against all microorganisms and is non-corrosive to the items being

sterilized.

IPLEASE GO TO WORKSHEET # 3 ON PAGE 38.

WORKSHEET # 3

DIRECTIONS: Let's ,::eview your knowledge of the skills you have just learned.

For the following st:tements 1 - 5 below, fill in the blanks with the correct response.

1. Large GYN instrument sets may be wrapped utilizing the method when

using both wrappers simultaneously.

2. The method of wrapping can also be used to wrap GYN sets and individual

instruments.

3. The prime function of a package containing an instrument is to ensure that

is maintained until the package is opened intentionally.

4. The date stamped on the set must contain the date and the

date.

5. TWo things that are wri'-ten on the sterilization tape are the set and

your

DIRECTIONS:

For the following statements 6 - 10 below, the statements are either True or False.

If the statement is True, circle A4 if the statement is False, circle B.

6. The probability of contamination occurring is event rather than time related?

A. True

B. False

7. Materials used for wrapping should be free from memory?

A. True

B. False

8. The following items such as curettes and clamps are items not to be steam sterilized?

A. True

B. False

42

9. Steam is suitable for plastics, oils, greases, and powders?

A. True

B. False

10. Metal equipment absorbs moisture during the heat-up phase of sterilization?

A. True

B. False

DIRECTIONS:

For thethcomplete statements 11 - 14 below, one or more of the completions are correct.

Decide which completion or completions are correct and fill in the blank with one of






5. All are correct

YOUR CHOICE

11. In wrapping sets, which conditions are necessary for the materials being used?

A. Free of toxic ingredients

B. Free of non-fast dyes

C. Nonabrasive


YOUR CHOICE

39 43

12. In utilizing an instrument set, which condition or conditions require the use

of a steam indicator tape?

A. Metal instruments

B. Rubber tubing

C. Liquids

D. Perishable materials

YOUR CHOICE

13. If the steam chemical indicator in a set does not change after going through the

sterilization cycle in the steam autoclave, what action or actions should you

take?

A. Consider the set not sterile

B. Re-wrap and re-sterilize the set

C. Consider the possibility of faulty indicator tape

D. Consider the set sterile

YOUR CHOICE

14. There are several advantages of gas sterilization:

A. Effective against all microorganisms

B. High pressure is necessary to ensure sterilization

C. It is non-corrosive

D. Short exposure time

YOUR CHOICE



FILL IN THE BLANKS

1. Large GYN instrument sets may be wrapped utilizing the oblong (square) method

when using both wrappers simultaneously.

2. The envelope method of wrapping can also be used to wrap GYN sets and individual

instruments.

3. The prime function of a package containing an instrument is to ensure that

sterility is maintained until the package is opened intentionally.

4. The date stamped on the set must contain the current date and the expiration

date.

5. info things that are written on the sterilization tape are the set identification

and your ititials.

TRUE OR FALSE

6. A

7. A

8. B Curettes and clamps are metal instruments that are steam sterilized.

9. B Gas is suitable for plastics, oils, greases, and powders.

10. B Moisture rolls off of metal equipment in the heat-up phase of sterilization

and cannot absorb any moisture. Therefore, a towel lined tray is necessary to

absorb the moisture that is formed with metal instruments in the steam auto-

claving process.

445

MULTIPLE CHOICE

11. 1

12. 1

13. 1

14. 2

IF YOU HAVE SUCCESSFULLY COMPLETED THE WRAPPING SKILLS PORTION OF THIS MODULE

WITH 100% ACCURACY, CONGRATULATIONS! THERE ARE A FEW MORE PAGES TO READ. PLEASE

CONTINUE.

IF YOU HAVE NOT SUCCESSFULLY MASTERED THE MATERIAL, HOWEVER, REREAD THIS

SECTION ON PAGES 32 - 37 AND REPEAT WORKSHEET # 3. IF YOU DO NOT MASTER THE MATERIAL

WITH 100% ACCURACY THIS TIME, PLEASE CONSULT THE INSTRUCTOR BEFORE ATTEMPTING TO

CONTINUE.4-6

42

ICONCLUSION -1..1,k

As a central processing technician, you alone are responsible for the safety

and well-being of more patients in the hospital than any other person. This is be-

cause you are capable of guaranteeing that every instrument that is used in the

operating room vhich has been processed in the CPD area is sterile. This means that

it is totally free from any living harmful organism that can cause an infection.

Remember, it is by your efforts that patients who receive equipment that is

processed in your area are ensured of a safe product tor their care. To help you

reach this goal, you have been exposed to the primary areas of processing instruments

which are vital tools needed to produce a sterile product. Do you now think you can

meet this challenge?

PLEASE GO TO THE POSTTEST ON PAGE 44.

POSTTEST

VIRECTIONS:

For the following statements 1 - 10 below, the statements are either True or False.


1. Terminal sterilization(autoclaving) is the most appropriate method of

sterilization?

A. True

B. False

2. Instruments must be clean, dry, and unlocked to assure their proper assembly

and sterilization process?

A. True

B. False

3. The sharp ends of instruments do not need to be protected in the assembly process?

A. True

B. False

4. A cloth lined or foam lined pen is necessary in steam ste i7ation to facilitate

drying of instruments?

A. True

B. False

5. The primary reason forsterilization of all instruments is to kill all

microorganisms?

A. True

B. False

6. Items requested by the operating room should take priority over routine tasks?

A. True

B. False

4844

7. It is permissible to send items that will be used on patients to the operating

room with tears and holes in their wrappers without consulting the OR personal

first?

A. True

B. False

8. Ndssing items from instrument sets do not need to be located before attempting

to wrap the set in question?

A. True

B. False

9. The instrument resource book is an excellent tool which can be utilized for

identification of unfamilar instruments?

A. True

B. False

10. The maximum weight of all instrument sets should not exceed 30 lbs?

A. True

B. False

DIRECTIONS:

For the following statements 11 - 16 below, fill in the blanks with the correct

response.

11. sterilization can be used to sterilize most metal and nonperishable

items.

12. Ethylene oxide is a form of sterilization.

13. A should be worn when leaving the central processing area.

.14. The and dates are necessary controls to be stamped on an

item or set before sterilization.

15. The of the set is written on the sterilizing tape to properly

distinguish this set from other sets.

45 49

16. Microbiology studies all forms of

DIRECTIONS:

For the incomplete statements 17 - 22 below, one or more of the completions are

correct. Decide which completion or completions are correct and fill in the blanks

with one of the following numbers next to "YOUR CHOICE" if:





5. All are correct

YOUR CHOICE

17. Aerobes can live in an environment which contains:

A. Air

B. Nb air

C. Oxygen

D. Nb oxygen

YOUR CHOICE

18. Diseases in hospitals may be caused by:

A. Pathogens

B. Nbsocomial infections

C. E. Coli

D. Nbne of the above

YOUR CHOICE

46'0





5. All are correct

19. A sonic washer is capable of producing the following:

A. cavitation

B. Ultra-sound waves

C. Removal of soil and debris


YOUR CHOICE

20. The following instruments should be washed by hand to provent damage:

A. Large retractors

B. Ophthalmology instruments

C. Glass

D. Screws

YOUR CHOICE

21. A wire mesh tray is designed for:

A. Effective sterilization of instruments

B. Drying of instruments

C. Orderly arrangement of instruments


YOUR CHOICE





5. All are correct

22. Which instrument or instrulinnts are not found routinely in a GYN set?

A. Rodgers

B. Haneys

C. Kellys

D. Doyens

YOUR CHOICE


5248

POSTTEST ANSWERS

TRUE OR FALSE

1. A

2. A

3. B All sharp ends of instruments need to be protected in the assembly process

so they do not injure the patient or the processor and also to protect the

instrument from breaking, cracking, or bending during the assembly process:

4. A

5. A

6. A

7. B Items that are sent to the OR with holes or tears in the wrappers are to be

considered contaminated.Therefore, it is essential that the OR personnel be

notified of this situation so that they can make a decision about the item.

8. B All items that are missing from a se -. ofinstruments need to be located before

attempting to assemble the set. Incomplete instrument sets are useless in some

surgeries and replacements are not always available immediately.

9. A

10. B The maximum weight of instrument sets should not exceed 17 lbs.

FILL IN THE BLANKS

11. Steam sterilization can be used to sterilize most metal and nonperishable items.

12. Ethylene oxide is a form of ms sterilization.

13. A lab coat (cover gown) should be worn when leaving the central processing area.

14. The current and expiration dates are nucessarycontrols to be stamped on an item

or set before sterilization.

15. The identity. of the set is written on the sterilizing tape to properly distinguish

this set from other sets.

49

16.

MULTIPLE

Mdcrobiology studies all forms of microorganisms.

CHOICE

17. 2

18. 1

19. 1

20. 3

21. 1

22. 1

5054

APPEgDIX A:

GLOSSARY OF TERNS

5551

GLOSSARY OF TERMS

AEROBIC - capable of growing in the presence of free oxygen.

ANAEROBIC - capable of growing in the absence cf free oxygen.

AUTOCLAVE - a device used for sterilization of materials by gas or steam under

pressure.

BACILLUS - a rod-shaped bacteria, a genus of the family Bacillacae.

BACTERIA - single celled vegetable microbes that reproduce by splitting; this is one

type of microorganism which is of great concern to hospital personnel because

it is difficult to destroy and produces many different diseases.

CASE CART - system used by which all sterile supplies needed in an area, such as the

operating room for a surgical procedure, are placed in a closed covered cart

in the central processing area and delivered to the appropriate area.

CAVITATION - the rapid formation and collapse of low pressure bubbles in liquids by

means of mechanical forces.

CHEMICAL INDICATOR - a common name for Sterilization Process Monitor.

CLEANING - removal of all visible dust, oil and any other foreign matter.

COCCUS - a spherical bacterium; form of a word,from the Greek meaning "berry."

CONTAMINATION - the act of making something impure or unclean.

CONTROL NUMBER - an assigned number used to more easily identify equipment, rather

than to use the hard to find, hard to read serial number.

DECONTAMINATION - a process whereby instruments, needles and other items are freed of

the contaminating agents and rendered safe for human handling without further

recourse to individual protective measures.

EXPIRATION DATE - date indicating coming to an end; i.e. end of effective shelf-life

of a supply item.

FUNGUS - a class of vegetable organisms such as mushrooms, toadstools and molds.

GERM - lay.term-for.microorganismsz

GERM THEORY OF DISEASE - the analysis of a set of facts establishing that germs or

52 0r6

disease causing microorganisms do exist.

GRAM STAIN - a differential stain by which bacteria are classed as gram-positive or

gram-negative depending upon whether they retain or lose the primary stain

(crystal violet) when subjected to treatment with a decolorizing agent.

GYN - abbreviation for gynecology.

GYNECOLOGY - the science dealing with diseases which are peculiar to women.

HYSTERECTOMY - excision of the uterus.

MEMORY - the inherent ability of a substance to return to its original shape and

contours.

MaCROBIOLOGY - the study of microorganisms.

PATHOGENIC ORGANISMS - microorganisms which cause diseases.

ROD - a straight, slim mass of substance related to microorganisms; i.e. rod-shaped

bacterium.

SPIRILLUM - a spiral-shaped form of bacterium.

SPORE - a'resistant body formed by certain microorganisms; resistant resting cells;

primitive unicellular reproductive bodies; hard to kill; the "seed" stage of

certain bacteria; very resistant to destruction because of hard outer layer;

formed when certain bacteria are dried, but starts growing when exposed to

moisture and warmth.

STEAM - water vapor at 212°F (100°C) or above.

SuRILIZATION - a process by which all forms of microbial life including bacteria,

viruses, spores, and fungi are completely destroyed.

VIRUS - one of a group of minute infectious agents that grow only in living tissues

or cells; can be observed only under an electron miLroscope.

WASHER/STERILIZER - mechanical equipment for decontamination.

33

APPENDIX B:

INSTRUMENT SETS: PREPARING FOR STERILIZATION

08

54

INSTRUMENT SETS: PREPARING FOR STERILIZATION

OPEN, UNLOCK, OR DISASSEMBLE INSTRUMENTS.

USE MESH-swum TRAYS.

* Appendix: B is from:

Kirkwood, Edna K. " Guideline for Preparing and Sterilizing Wrapped Packs," AMSCO


55

APPENDIX C:

INSTRUMENT SETS: WRAPPING FOR STERILIZATION

;ETS : WRAPPING FOR STERILIZATION

PLACE OPEN CD HUCK TOWELIN BOTTOM OF TRAY.

FOLD TOWEL EXCESSOVER INSTRUMENTS.

PLACE INSTRUMENTS ON TOWEL.

PLACE CHEMICAL INDICATORON INSTRUMENTS.

* Appendix C is from:

Kirkwood, Edna K. "Guideline for Preparin .ond SteW):i'a.u7 Wrapped Packs," AMECO


61

APPENDIX D:

INSTRUMENT SETS: ENVELOPE METHOD OF WRAPPING

58 62

INSTRUMENT SETS: ENVELOPE METHOD OF WRAPPING

12

3

* Appendix D is from:

4

ENVELOPE METHOD Instrumorda.



59, 63

INSTRUMENT SETS: ENVELOPE METHOD OF WRAPPING CONTINUED

8

5

7

9

* Appendix D is from:

Kirkwood, Edna K. "Guideline for Preparing and Sterilizing Wrapped Packs," ANSCO


60 64

APPENDIX E:

INSTRUMENT SETS: OBLONG (SQUARE) METHOD OF WRAPPING

INSTRUMENT SETS: OBLONG (SQUARE) METHOD OF WRAPPING

3

5

2

4

OBLONG METHOD Inottuments.

* Appendix E is from:



6662

APPENDIX F:

ABDOMINAL HYSTERECTOMY SET: INSTRUMENT COUNT FORM

67

63

ONECDMMIMIAIL_ 1-11(TEMEICTMMYINSTRUMENT COUNT FORM

PgliA DESCRIPTION UTY CPD PRE-OP POST-OP

Needle Holder Long, 10"Metz Long Curved 1

Mayo Long Curved 1

Mayo Long Straight 1

Kelly Long 4Heaney LongRodgers LongKochners Long 4Tenaculum Long Single Tooth 1

Tenaculum Long Double Tooth 1

O'Connor-Sullivan w/Blades 4Singley Forceps Long 2Allis Clamps Long 2Babcocks Long 4

Total Instrument Count:

Counted By:

C.P.D. USE ONLY: Datfl Assembled:

Wrapper Size: 54 x 72Wrapped How: SquareSterilized: Steam

SPECIAL INSTRUCTIONS:

Expiration Date: 1 MonthStored In: CPD

* Appendix F is an instrument count sheet from:

St. John Hospital Division of the St. Clair Health Corporation

Detroit, Michigan.

68

64Vol. lEdit Ref: 12 R/R: 09/17/1986

APPENDIX G:

VAGINAL HYST2ECTOMY SET: INSTRUMENT COUNT FORM

6965

1/4,041M I NMI-. HIVS-1-1EIRIEM-IrDIMINe ETINSTRUMENT COUNT FORM

plum * DESCRIPTION pTY CPD PRE-OP POST-OP

Eastman Lateral Rectractor.Weighted Speculum . . ..

1

1

Small DeaverHaney Needle HoldersHaney Clamps 4

Rodger Clamps 4

Long Kochers 4

Short Kochers 4

Short Allises 6

Long Allises 2Single Tooth Tenaculum . 1

Double Tooth Tenaculum 1

Total Instrument Count: 31

Counted By:

C.P.D. USE ONLY: Date Assembled:

Wrapper Size: 54 x 54Wrapped How: 2 SquareSterilized: Steam

SPEr.TAL INSTRUCTIONS:

Expiration Date: 1 MonthStored In: CPD

* Appendix G is an instrument count sheet from:

St. John Hospital Division of the St. Clair Health Corporation

Detroit, Michigan.

70

66Vol 2 Edit Ref: 9 R/R: 10/31/19E16

REFERENCES AND SUGGESTED READINGS

BOOKS:

Gruendemann, Barbara J., and Meeder, Jargaret Huth. Alexander's Care of the Patient

in Surgery, 7th ed. St. Louis: the C, V. Mosby Company, 1983.

Sybron, Medical Products Division. Demonstration Guide for Basics of Ethylene

Oxide. Rochester: Castle Company, 1976.

Sybron, Medical Products Division. Demonstration Guide for Basics of Microbiology.

Rochester: Castle Comrany, 1976.

Sybron, Medical Products Division. Demonstration Guide for Preparation and Packaging.

Rochester: Castle Company, 1976.

JOURNALS:

Byrd, Waveline Sue. "A_Case.Cart System- Our Secret to Success," Hospital Topics,

Vol. 63 (November/Decembar, 1985) No. 6, pp. 46 - 48.

Jevitt, Dorothy. "Expiration Dating," Journal of Healthcare Material Management,

Vol. 3 (November/December, 1985) No. 6, pp. 22 - 24.



Laughlin, Thomas D. "Fundamentals of Cleaning for Central Service," Hospital Tbpics,

Vol. 64 (September?October, 1986) No. 5, pp. 42 - 48.

"Recommended Practices for Inhoital Packaging Materials," AORN, Vol. 37 (February,

1983) No. 2, pp. 255 - 256.

Reichert, Marimargaret. "Processing Reusable Medal Devices, "Journal of Healthcare

MP2220111, Vol. 4 (March/Apri)., V4.16) No. 2, pp. 40 - 44.

Ryan, Peggy. "How to Implement Case Cart Systems for Cenizal Service and OR," Hospital

Topics, (November/December, 1978) pp. 5 - 22.

Siegal, William C., and Bunn III, William. "The Ethylene Oxide Standard - Medical and

Legal Aspects of Compliance," Journal of Hospital Supply, Processing and Distrib-

ution, Vol. 3 (May/June, 1985) No. 3, pp. 40 - 44.

71

67

DOCUMENT RESUME ED 283 023 CE 047 486 Wojcik, Roseann B ... · assembling, and wrapping the medical instruments used for vaginal and abdominal hysterectomies. Appendixes to the module

Documents